Table 2.

Specific Considerations for Medication Use in PUI or COVID-19–Positive Patients During Labor, Delivery, and the Postpartum Period

	Considerations	Case Context	Mechanism
Oxygen9	The routine use of oxygen for fetal indications should be suspended	Overall, the use of oxygen for fetal indications is controversial	The use of high-flow nasal cannula or facemask oxygen may be an aerosolizing procedure
Nitrous oxide9	Discuss the relative risks and benefits of nitrous oxide for labor analgesia and consider suspending its use	Overall, for all parturients	“There is currently insufficient information about the cleaning, filtering, and potential aerosolization of nitrous oxide in labor analgesia systems in the setting of COVID-19”
Remifentanil/ fentanyl14	Consider avoiding the use of IV PCA opioids (remifentanil/fentanyl) for labor analgesia	Women at risk for respiratory depression and opioid-induced nausea and vomiting	Opioid-induced respiratory depression increases the risk of sedation, respiratory depression, and oxygen desaturation, and increases the risk for emergent airway instrumentation and aerosolizing procedures
Ketorolac/ ibuprofen9,15	For women who are asymptomatic or mildly symptomatic that require analgesic medication beyond acetaminophen, NSAIDs can continue to be used, as the alternative of opioids likely poses more clinical risks. For sick COVID-19 patients, consider avoiding NSAIDs	It has been suggested that the use of NSAIDs for management of COVID-19 symptoms may aggravate COVID-19 infection trajectory (although the evidence is not robust) The use of ACE inhibitors was suggested to increase the risk for COVID-19 infection	NSAIDs are associated with increased ACE2, to which COVID-19 binds
Dexamethasone9	Consider avoiding the use of dexamethasone for PONV prophylaxis	In all women undergoing cesarean delivery, alternative antiemetics should be administered to prevent vomiting	Prolonged exposure to high-dose steroids has been associated with worsening COVID-19 outcomes in the general population
Carboprost (Hemabate)14	Consider avoiding the use of carboprost for treatment of uterine atony	For women at risk of bronchospasm, use alternative second-line uterotonics	Prostaglandin F2 alpha causes bronchoconstriction and pulmonary vasoconstriction
Magnesium sulfate9	Consider avoiding or as an alternative to usual dosing, a 4g bolus dose may be preferred in the setting of mild respiratory distress	For women with increasing oxygen requirement, the risk:benefit ratio should be considered before using magnesium for fetal neuroprotection, or for preeclampsia without severe features	Magnesium sulfate has central nervous system and respiratory depressant effects

Abbreviations: ACE, xxx; COVID-19, Coronavirus Disease 2019; IV, xxx; NSAIDs, nonsteroidal anti-inflammatory drugs; PCA, xxx; PONV, xxx; PUI, persons under investigation.